Improvement of Spastic Stroke Hemiparesis Using rTMS Combined with Motor Training
Stroke is the second most common cause of death and the leading cause of chronic disability in adults worldwide. Patients with chronic stroke often show increased flexor hypertonia in their affected upper limbs. Although an intervention strategy targeting the extensors of the affected upper limb might thus be expected to have benefits for functional recovery, conventional repetitive motor training has limited clinical utility. Recent studies have shown that repetitive transcranial magnetic stimulation (rTMS) could induce motor recovery. Therefore, we developed a new hybrid rehabilitation comprised of rTMS and motor training of the extensors in order to counteract flexor hypertonia. Five hertz rTMS of the upper-limb area of the primary motor cortex (M1), combined with extensor motor training, had a greater effect on motor recovery than either intervention alone in chronic stroke hemiparesis. It resulted in an improvement of extensor movement and grip power, along with a reduction of flexor hypertonia in their paretic upper limbs. In addition, we found the long-lasting effect for more than 2 weeks, by repeating the hyprid rehabilitation 12 times in patients for 6 weeks. These findings indicate that this method can facilitate use-dependent plasticity and achieve functional recovery of motor impairments. This new hybrid form of rehabilitation could be a powerful rehabilitative approach for patients with hemiparetic stroke.
KeywordsTranscranial Magnetic Stimulation Anodal tDCS Grip Power Motor Training Extensor Digitorum Communis
- 13.Taub E (1980) Somatosensory deafferentiation research with monkeys: implications for rehabilitation medicine. In: Ince LP (ed) Behavioral psychology in rehabilitation medicine: clinical applications. Williams & Wilkins, New YorkGoogle Scholar
- 25.Fregni F, Boggio PS, Valle AC, Rocha RR, Duarte J, Ferreira MJ, Wagner T, Fecteau S, Rigonatti SP, Riberto M, Freedman SD, Pascual-Leone A (2006) A sham-controlled trial of a 5-day course of repetitive transcranial magnetic stimulation of the unaffected hemisphere in stroke patients. Stroke 37:2115–2122PubMedCrossRefGoogle Scholar
- 45.Hachinski V, Donnan GA, Gorelick PB, Hacke W, Cramer SC, Kaste M, Fisher M, Brainin M, Buchan AM, Lo EH, Skolnick BE, Furie KL, Hankey GJ, Kivipelto M, Morris J, Rothwell PM, Sacco RL, Smith SC Jr, Wang Y, Bryer A, Ford GA, Iadecola C, Martins SCO, Saver J, Skvortsova V, Bayley M, Bednar MM, Duncan P, Enney L, Finklestein S, Jones TA, Kalra L, Kleim J, Nitkin R, Teasell R, Weiller C, Desai B, Goldberg MP, Heiss W-D, Saarelma O, Schwamm LH, Shinohara Y, Trivedi B, Wahlgren N, Wong LK, Hakim A, Norrving B, Prudhomme S, Bornstein NM, Davis SM, Goldstein LB, Leys D, Tuomilehto J (2010) Stroke: working toward a prioritized world agenda. Stroke 41:1084–1099PubMedCrossRefGoogle Scholar